Comic Sans MS:

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Monotype Sorts:

Location of poliovirus by type, 2007 ** three cases (one in UP, two in Bihar) reported mixture of P1 wild and P3 wild

Wingdings:

Polio cases, India P1 wild P3 wild * data as on 19 March 2010

NPSU:

Polio type 1

Microsoft Excel Chart:

Polio cases of type 1, India Year * data as on 19 March 2010

Microsoft Graph 2000 Chart:

Polio cases of type 1, Uttar Pradesh Year * data as on 19 March 2010

Microsoft Office Excel Worksheet:

Polio cases of type 1, Bihar Year * data as on 19 March 2010

Microsoft Graph Chart:

Sustained intensification in the access compromised areas around Kosi river Grid areas: Groups of villages from different districts clustered in hard to reach riverine areas Dedicated SMOs, field volunteers and social mobilizers assigned to each grid to support microplanning, training, community mobilization and monitoring

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Objective of AFP surveillance Reliably detect areas where polio transmission is occurring or likely to occur

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Principle of AFP Surveillance in identifying polio cases Identify children with the SYNDROME of Acute Flaccid Paralysis Acute - Sudden onset, Rapid progression Flaccid - Floppy or Soft and yielding to passive stretching at anytime during the illness . Paralysis is loss of strength of muscles, Severe loss of motor strength is called paralysis or plegia Paresis- less severe loss of motor strength

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Definition of AFP for surveillance purposes Sudden onset weakness and floppiness in any part of the body in a child < 15 years of age or paralysis in a person of any age in which polio is suspected.

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Logic of AFP investigation & stool sample collection Sensitivity increases when all AFP cases are investigated Testing of stools of all AFP is the most valid test for identification of Polio ALL cases with ‘Acute Flaccid Paralysis’ should be reported and their stools must be tested!! Even if other ‘tests’ (CT scan, MRI, etc.) or additional clinical information point to other diagnoses, their stools must be tested to rule out Polio

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Reporting All cases of acute flaccid paralysis should be reported immediately ALL AFP cases reported within 6 months of onset of paralysis should be investigated All reporting units, informers and other contacts should continue to report AFP cases as per existing case definition – there is no change in the definition

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Action when AFP is reported FIRST – Start stool collection process Investigate - SMO/ DIO - Confirm if AFP,if not reject case and record the same . There is only one category of cases - AFP Allot EPID number & Report the case as AFP CIF & LRF should be filled . Use the revised CIF/ Linelist form . Ensure that stools are transported to lab in cold chain NPSU will Classify after lab result is received Give feedback to the source that the AFP reported was/ was not polio. Maintain documentation at ALL levels.

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Therefore… The basic system of AFP surveillance remains unchanged To enhance sensitivity, all cases of acute flaccid paralysis should be reported and investigated Borderline cases should be included and stool specimens tested

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Strategies of Polio Eradication:

VIROLOGIC CLASSIFICATION SCHEME * 2 SPECIMENS, AT LEAST 24 HOURS APART AND WITHIN 14 DAYS OF PARALYSIS ONSET; EACH SPECIMEN MUST BE OF ADEQUATE VOLUME (8-10 GRAMS) AND ARRIVE AT A WHO ACCREDITED LABORATORY IN GOOD CONDITION (i.e. NO DESSICATION, NO LEAKAGE, ADEQUATE DOCUMENTATION AND EVIDENCE THAT THE REVERSE COLD CHAIN WAS MAINTAINED) NO WILD POLIOVIRUS AFP WILD POLIOVIRUS INADEQUATE STOOL SPECIMENS TWO ADEQUATE* STOOL SPECIMENS NO RESIDUAL WEAKNESS CONFIRM COMPATIBLE DISCARD DISCARD RESIDUAL WEAKNESS, DIED OR LOST TO F/U DISCARD EXPERT REVIEW

PowerPoint Presentation:

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HOT CASE A case of AFP with any of the following set of conditions - Age less than 5 year plus history of fever at onset plus asymmetrical proximal paralysis. Age less than 5 year with rapidly progressive paralysis leading to bulbar involvement (cranial nerves are affected) and death. Any case which in the opinion of SMO/DIO looks like polio.

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CONTACT SAMPLES To be considered for cases fulfilling criteria like Hot cases, but adequate samples from case could not be taken Such cases or any other situations where SMO / DIO feels the necessity of contact samples, should be discussed with RTL NPSP

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Month wise Cases Reported by Ahmedabad Muni.Corpn.

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Month wise Cases Reported by V.S.Hospital, Ahmedabad Muni.Corpn.

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Cases Reported by Ahmedabad Muni.Corpn.

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Cases Reported by diiferent RUs of Ahmedabad Muni.Corpn.

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Cases Reported by Civil Hospital of Ahmedabad Muni.Corpn.

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Cases Reported by V.S. Hospital of Ahmedabad Muni.Corpn.

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Cases Reported by L.G. Hospital of Ahmedabad Muni.Corpn.

Differential diagnosis?:

Cases Reported by Shardaben Hospital of Ahmedabad Muni.Corpn.

STOOL COLLECTION, STORAGE , TRANSPORT.:

MEASLES

GOLD STANDARD FOR AFP SURVEILLANCE:

Top Ten Causes of Death in Children Aged <5 Years, Worldwide, 2000 Source: World Health Organization, Global Burden of Disease 2000Project Measles is the biggest Killer among VPDs!

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Measles: Clinical features Incubation period from exposure to onset of fever is usually 10 days. Initial symptoms and signs are high fever, runny nose, coryza, cough, red eyes and Koplik spots (small white spots on the buccal mucosa). Characteristic erythematous (red) maculopapular (blotchy) rash appears on the 3rd to 7th day, starting behind the ears and on the hairline and then spreading to the rest of the body. Temperature subsides after 3–4 days; the rash fades after 5–6 days. Measles is highly infectious from the start of the prodromal period until approximately 4–5 days after the rash appears.

CONTACT SAMPLES:

Complications Complications develop in up to 30% of cases. Complications occurring in the first week of illness, such as croup, diarrhoea and pneumonia, are usually due to effects of the measles virus and are rarely life-threatening. Later complications are usually due to secondary viral or bacterial infections – post measles pneumonia, diarrhoea and croup are the most common life-threatening complications Vitamin A deficiency: Keratoconjunctivitis. Measles increases the need for vitamin A and often precipitates xerophthalmia.

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Blindness due to scarring, as a result of vitamin A deficiency and/or conjunctivitis. Encephalitis: caused by the measles virus itself, occurs on about the 5th day of the rash. Otitis media Uncommon: Myocarditis, Pneumothorax, Pneumomediastinum, Appendicitis, Subacute Sclerosing Panencephalitis Case–fatality rates are estimated to be 3–5% in developing countries but may reach as much as 10–30% in displaced populations. CFR in India: 0 - 23.9% (Median 3.7%) Complications…

Cases Reported by Shardaben Hospital of Ahmedabad Muni.Corpn. :

Measles Surveillance Activities Case Definition Activities at reporting site level Activities at district level Activities at state level

MEASLES:

Case Definition of Clinical Measles Any person in whom clinician suspects measles infection or Any person with fever and maculo papular rash with cough or coryza (running nose) or conjunctivitis (red eyes) For epidemiological investigation, clinical measles would be a case within last 3 months

Top Ten Causes of Death in Children Aged <5 Years, Worldwide, 2000:

Measles virus and measles:

Key Information to be Collected on Clinical Measles Cases by Reporting Sites Person Age Vaccination status (+ date of last vaccination) Place Residence at time of rash onset Time D ate of rash onset = “Date of Onset” Objective is to detect clustering of clinical measles cases and initiate outbreak investigation Detection of clustering is done at district level

Complications:

Operational criteria for conducting extensive outbreak investigation > 5 clinical cases of measles in a block in a week OR > 1 death due to measles OR > 5 clinical cases in an area bordering a block with continuous areas Remember Measles never occurs as an isolated case. Decision to investigate an outbreak should be taken at District Level

Complications…:

Desk Review of Measles data every Tuesday at district level Identify blocks with 5 cases or 1 death in a week Which potential outbreaks to investigate? Any Death in a block 5 cases in a block If yes, ASSIGN OUTBREAK ID & conduct preliminary field search in area to look for additional cases Assess if these cases are clustered in same/ adjacent villages If additional cases found (~20 cases), conduct detailed investigation

Prevention: Measles vaccine:

Measles and vitamin A Low vitamin A levels: ~ higher rates of complications & deaths Synergy of measles & vitamin A deficiency have additive pathological effect on epithelia and immune system This synergy causes ~ 1 million deaths Measles itself may lead to severe acute depletion of vitamin A Precipitates keratomalacia & blindness Role of Vitamin A in measles 2 doses reduce mortality by 48-81%